Inha University Hospital

Objective The aim of this study is to assess the predictive and prognostic value of p16 in recurrent/metastatic HNSCC patients treated with molecular targeted agents (MTAs) or immune checkpoint inhibitors (ICIs). Study design The TRIUMPH trial (NCT03292250) was a multi-arm phase II umbrella trial using next-generation sequencing for patients with HNSCC. Patients were assigned to specific treatment arms including PIK3CA, EGFR/HER2, FGFR, CDK4/6 inhibitors, and ICI based on their genomic profiles. We performed post hoc analysis using 86 patients who had available p16 immunohistochemistry results. ORR, PFS, and OS were analyzed by p16 positivity. Results The p16 positivity rate was 33.7%. ORR was 20.7% for p16 (+) compared to 8.8% for p16 (–) patients (P = 0.072). Median PFS was 3.8 months for p16 (+) and 1.8 months for p16 (–) (P = 0.030). Median OS was 12.9 months for p16 (+) and 6.2 months for p16 (–) (P = 0.100). Conclusion Patients with p16 (+) showed longer PFS and OS compared to p16 (–) patients. This suggests that p16 has prognostic and predictive values in HNSCC patients who are treated with MTAs or ICIs.

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Neuroinflammation is increasingly recognized as a key driver of progressive supranuclear palsy (PSP), but the role of blood inflammatory markers remains unrevealed. This prospective cohort study aimed to characterize blood inflammatory protein profiles in PSP and to assess their associations with clinical severity, longitudinal progression, blood-based neurodegeneration markers, and brain morphometric changes. We enrolled 71 probable PSP patients and 30 age-matched healthy controls. Plasma concentrations of 39 inflammatory proteins were measured using a proximity extension assay. Data on clinical assessments, volumetric MRI, and blood biomarkers, including neurofilament light chain (NfL), phosphorylated tau 231, soluble triggering receptor expressed on myeloid cells 2 (sTREM2), and glial fibrillary acidic protein, were obtained. Follow-up clinical assessments were available for 56 patients at 6 months and 45 at 12 months. Principal component (PC) analysis identified three components explaining 55.6% of the variance. All PC scores were elevated in the PSP group compared to controls. PC1, mainly driven by interleukin (IL)-7, vascular endothelial growth factor A, and pro-epidermal growth factor, was associated with greater clinical severity, higher sTREM2 levels, and more pronounced atrophy in the cerebellum and limbic areas. PC3, mainly driven by IL-6, C-X-C motif chemokine 9, and oncostatin-M, was associated with greater clinical severity and faster disease progression, higher NfL levels, and more extensive atrophy in the frontoparietal regions and caudate nucleus. PC2 showed no associations with baseline and longitudinal outcomes. These observations suggest that blood inflammatory proteins reflect the neurodegenerative processes underlying PSP and serve as prognostic biomarkers.

As information and communication technology continues to advance rapidly within the healthcare sector, digital literacy and nursing informatics competency have become fundamental skills required for nurses. Nurses with digital literacy and nursing informatics competency exhibit enhanced nursing performance, high productivity, and improved work efficiency. Research remains limited on how digital literacy and nursing informatics competency influence nursing outcomes, such as burnout and work engagement. Therefore, this cross-sectional exploratory study utilized the framework of the Job Demands–Resources (JD-R) model to investigate how digital literacy and nursing informatics competency function as job resources and influence nurses’ burnout and work engagement. In June 2025, 130 nurses working in inpatient wards, intensive care units, and emergency unit of a tertiary hospital in South Korea were recruited using convenience sampling. Participants completed a questionnaire measuring their digital literacy, nursing informatics competency, positive organizational culture, work demands, burnout, and work engagement. In total, 130 valid questionnaires were analyzed using multivariable linear regression. Mediation analyses were performed to examine whether positive organizational culture mediates the relationship between digital literacy or nursing informatics competency and work engagement. Positive organizational culture fully mediated the relationship between digital literacy and work engagement (direct effect = 0.420, 95% CI [-0.142, 0.982]; indirect effect = 0.349, 95% CI [0.108, 0.623]). Nursing informatics competency was also found to indirectly affect work engagement through positive organizational culture (indirect effect = 0.072, 95% CI [0.006, 0.170]). This study extends the JD-R framework, by indicating that digital literacy and nursing informatics competency may operate as a personal resource that facilitates greater work engagement indirectly through the organizational resource of positive nursing culture. It emphasizes the interdependence between personal and organizational factors in shaping nurses’ work engagement. Therefore, strengthening nursing organizational culture is essential. Within such a positive culture, educational programs designed to improve nurses’ digital literacy and nursing informatics competency may further promote their work engagement.

Identifying the potential cause of embolic stroke of undetermined source is essential for secondary prevention. We analyzed retrospectively collected real-world data from the South Korean cohort with embolic stroke of undetermined source to examine trends in baseline characteristics, diagnostic practices, and secondary prevention strategies and to identify cardioembolic factors and supracardiac atherosclerotic lesions associated with stroke recurrence. We analyzed 5787 patients from the Real-World Study of Embolic Stroke of Undetermined Source cohort from 19 South Korean stroke centers (2014-2019). Baseline characteristics, diagnostic and secondary prevention trends were evaluated. Factors associated with 1-year stroke recurrence were identified using multivariable Cox regression analysis in 4036 patients with follow-up data. Over 6 years, vascular risk factors and cardioembolic evaluations significantly increased. Stroke recurrence was strongly associated with intracranial nonrelevant stenosis involving ≥2 vessels (hazard ratio [HR], 2.756, P<0.001), paroxysmal atrial fibrillation (HR, 5.590, P=0.033), atrial septal aneurysm (HR, 4.741, P=0.005), and serum creatinine levels (HR, 1.166, P=0.008). In patients without moderate-risk cardioembolic sources, a single intracranial nonrelevant stenosis and complex aortic atheroma were also linked to stroke recurrence. Intracranial nonrelevant stenosis and complex aortic atheroma, along with cardioembolic factors like paroxysmal atrial fibrillation and atrial septal aneurysm, are key predictors of stroke recurrence in embolic stroke of undetermined source, especially those without moderate-risk cardioembolic sources. These findings emphasize the need to consider both supracardiac atherosclerotic and cardioembolic mechanisms in embolic stroke of undetermined source and to develop tailored secondary prevention strategies for atherosclerotic stroke, particularly in cases with supracardiac atherosclerotic lesions to reduce stroke recurrence.

BackgroundDespite guideline recommendations, evidence for the use of non–vitamin K antagonist oral anticoagulant (NOAC) monotherapy in patients with atrial fibrillation after implantation of a drug-eluting stent remains limited.MethodsIn this multicenter, randomized, open-label, noninferiority trial in South Korea, we assigned patients with atrial fibrillation who had undergone the implantation of a drug-eluting stent at least 1 year earlier in a 1:1 ratio to receive NOAC monotherapy or combination therapy (NOAC plus clopidogrel). The primary end point was net adverse clinical events, a composite of death from any cause, myocardial infarction, stent thrombosis, stroke, systemic embolism, or major bleeding or clinically relevant nonmajor bleeding at 12 months. The noninferiority margin was 3.0 percentage points.ResultsA total of 960 patients underwent randomization: 482 patients to receive monotherapy and 478 to receive combination therapy. The mean age of the patients was 71.1 years, and 21.4% were women. At 12 months, a primary end-point event had occurred in 46 patients (Kaplan–Meier estimate, 9.6%) in the monotherapy group and in 82 patients (Kaplan–Meier estimate, 17.2%) in the combination-therapy group, for an absolute difference of –7.6 percentage points (95.2% confidence interval [CI], −11.9 to −3.3; P<0.001 for noninferiority) and a hazard ratio of 0.54 (95.2% CI, 0.37 to 0.77; P<0.001 for superiority). Major bleeding or clinically relevant nonmajor bleeding occurred in 25 patients (5.2%) in the monotherapy group and in 63 patients (13.2%) in the combination-therapy group (hazard ratio, 0.38; 95% CI, 0.24 to 0.60).ConclusionsAmong patients with atrial fibrillation who had undergone implantation of a drug-eluting stent at least 1 year earlier, NOAC monotherapy was noninferior to combination therapy for net adverse clinical events. (Funded by Cardiovascular Research Center and Samjin Pharmaceutical; ADAPT AF-DES ClinicalTrials.gov number, NCT04250116.)

Backgrounds: Stroke is a major complication in patients with heart failure with preserved ejection fraction (HFpEF), associated with significant morbidity and mortality. However, predictors of incident stroke in this population remain insufficiently characterized. Echocardiographic assessment of cardiac structure and function may serve as a valuable tool for stroke risk stratification in patients with HFpEF. Research Question: Which echocardiographic parameters are associated with the risk of stroke in patients with HFpEF? Methods: We pooled data from the echocardiographic sub-studies of the TOPCAT and PARAGON-HF trials, which included patients with HF and a LVEF ≥45%. The primary outcome was the centrally adjudicated incident of all types of strokes. Baseline clinical characteristics and echocardiographic parameters were compared between patients with and without incident stroke. The association of individual echocardiographic parameters with incident stroke was assessed using multivariable Cox models, adjusting for the CHA 2 DS 2 -VASc score, AF, anticoagulant use, systolic blood pressure, body mass index, race, treatment arm, and trial cohort. Results: Among 1,751 patients (654 from TOPCAT and 1,097 from PARAGON-HF; mean age: 73±9 years, female: 51%, mean LVEF: 59±9%, AF: 54%), 71 experienced a stroke over a median follow-up of 3.0 years (rate of 1.4 per 100 patient-years). Patients who had a stroke during follow-up had a higher prevalence of prior stroke, hypertension, and peripheral artery disease at baseline (all p&lt;0.05). After multivariable adjustment, greater LV mean wall thickness (adjusted HR: 1.45, 95% CI: 1.19-1.77 per 1 SD increase) and the presence of mitral annular calcification (MAC, adjusted HR: 1.92, 95% CI: 1.18-3.11) were independently associated with a higher risk of incident stroke ( Figure ). Conversely, other echocardiographic parameters, including LVEF, left atrial volume index, and left atrial strain, were not significant predictors of stroke. These findings were consistent irrespective of AF status, age, sex, prior stroke, anticoagulation use, and trial cohort (all intearaction P&gt;0.05). Conclusion: In this large cohort including over 1,700 patients with HFpEF with extensively well-characterized cardiac structure and function, LV mean wall thickness and MAC were independently associated with a higher risk of stroke, adding mechanistic insight and highlighting their potential role in stroke risk stratification in this population.